1 / 18

High mortality in Carnot city Central African Republic January-July 2012 ESCAIDE, 6 November 2013

High mortality in Carnot city Central African Republic January-July 2012 ESCAIDE, 6 November 2013. Nelly Fournet, EPIET cohort 2011. Economical and geographical background. CAR: 4 millions inhabitants 80% of population < 2 $ / day 45% of adults are illiterate

bena
Télécharger la présentation

High mortality in Carnot city Central African Republic January-July 2012 ESCAIDE, 6 November 2013

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. High mortality in Carnot city Central African RepublicJanuary-July 2012ESCAIDE, 6 November 2013 Nelly Fournet, EPIET cohort 2011

  2. Economical and geographical background • CAR: 4 millions inhabitants • 80% of population < 2 $ / day • 45% of adults are illiterate • Political instability / Isolated • Life of expectancy: 48 years

  3. Carnot city • 61 790 inhabitants • Agriculture replaced progressively by diamond mining • 2009 : diamond mining restricted → crisis → MSF opened a programme for acute malnutrition in children • 2010 : MSF opened an HIV programme

  4. Health situation in Carnot city • January-July 2011 : retrospective mortality survey • Crude Death Rate 3x higher than emergency threshold*: • CDR = 3.7/10,000/day (CI95% 3.0 – 4.6) • 0-5 DR = 7.0/10,000/day (CI95% 5.3 – 9.,3) → MSF actions: → Primary health care → Paediatric ward → Measles mass vaccination campaign → Mortality surveillance system *CDR = 1 death / 10,000 inhabitants / day 0-5 DR = 2 deaths / 10,000 children <5 y / day

  5. Objectives Main objective: • Estimate the crude death rate (CDR) and the specific death rate among children <5y (0-5 DR) in Carnot city between January and July 2012 Secondary objective: • Estimate the main causes of deaths → In order to re-adjust MSF interventions

  6. Study design • Cross-sectional retrospective survey • Recall period: January 2012 – July 2012 • Information collected: • Number of persons in the household at the date of the survey • Number of deaths / births / who joined / left the household + dates • Cause of death (simplified verbal autopsy) • Study population: • Population: all persons living more than 1 month in Carnot • Household: all persons sharing the same meal and under the responsibility of the same person

  7. Methods • Two-stage cluster sampling • Stage one: selection of the neighbourhoods (clusters) proportional to population size • Stage two: within each cluster, selection of the households with the EPI method • Sample size: • Sample size: 3,717 persons = 710 households • 30 clusters selected: 24 households per cluster • Survival analysis: • CDR and 0-5 DR estimations and CI95% • Trends over the time

  8. Description of the population 46% 21%

  9. Death Rates 2011: • CDR = 3.7/10,000/day (CI95% 3.0 – 4.6) • Emergency threshold: CDR = 1/10,000/day • 0-5 DR = 7.0/10,000/day (CI95% 5.3 – 9.,3) • Emergency threshold: 0-5 DR = 2/10,000/day

  10. Trends over the recall period Specific death rate among children <5 years from January to July 2012, Carnot city, CAR

  11. Main causes of deaths • Children <5 years • 35% malaria • 10% neonatal deaths (without associated causes) • 7% diarrhoea • Adults >15 years • 30% HIV • 13% malaria • 10% accident (poisoning, trauma, bite…)

  12. Conclusion • Limitations: • Recall bias • Cause of deaths reported by verbal autopsy • Results specific to Carnot City, not generalize to CAR • Crude death rate and the specific death rate among children <5y decreased half compared to 2011 • Above emergency threshold • Main cause of death: HIV among adults and malaria among children

  13. Recommendations -> Strengthen collaboration with health local authorities -> Improve access and coverage of health care centres -> Improve paediatric and neonatal health care -> Improve malaria and HIV diagnosis, treatment and prevention • March 2013 : rebellion in Bangui (capital) → Overthrow of the government → Priority: care of injured persons

  14. Acknowledgement • Carnot city population • All Interviewers from CAR • MSF team in Carnot City • Sandra Cohuet, Epicentre, Paris • KlaudiaPorten, Epicentre, Paris • Susan Hahné, RIVM, the Netherlands

  15. Singuila !!!

  16. Definition of the main causes of deaths • Duration of the illness • Death linked with the pregnancy / the delivery • Neonatal death (<28 days) • Diarrhoea • Coughing / Respiratory troubles • Neurologic troubles • Malaria • Isolated fever • Measles • Trauma, injury • Pain in the mouth / difficulty to eat • Cutaneous problems / permanent scratching • Major loss of weight • Other

  17. Case definition of HIV and TB* HIV • Duration of the illness > 2 months before death • Associated with: • diarrhoea >1 month • or difficulty to eat • or cutaneous problems • or major loss of weight • Without associated TB diagnosis TB • Duration of the illness > 2 months before death • Associated with coughing > 1 month and loss of weigh *Tassie JM, Savignoni Alexia et al. Retrospective mortality survey in Rusinga Island, Suba district, Nyanza province, Kenya. Avril 2002. Rapport final In. Paris: Epicentre; 2002.

More Related